Clinical Congress News; October 9, 1996

WEDNESDAY « October 9, 1996

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The American College of Surgeons ¢ 82nd Clinical Congress * October 6-11, 1996 ¢ San Francisco

Clinical Congress News

Computers in the surgeon’s office

enhance surgical practice in many ways

he Regental Committee on
Informatics sponsored a panel
discussion yesterday morning
to consider the many and var-
ied applications of computer technol-
ogy in the surgeon’s office. Alfred M.
Cohen, MD, FACS, a member of the
committee, served as moderator.

An introduction was given by
Mitchell Morris, MD, FACS, associate
vice-president of informatics, M. D.
Anderson Cancer Center, University of
Texas, Houston.

Dr. Morris discussed ways in which
computer technology can add to the
value of a surgical practice. He pro-
vided an overview of basic computer

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computers can grealiy improve the care
of patients and populations of patients.
The technology is here—it is up to us
to figure out how best to use it,” Dr.
Morris said.

Retirement:

—~="SE:y A

The second speaker was Ivor Ben-
jamin, MD, assistant professor and di-
rector of information systems,
University of Pennsylvania Cancer Cen-
ter, Philadelphia. Dr. Benjamin de-
scribed and demonstrated a clinical
workstation prototype developed by the
Society of Gynecologic Oncologists that
to date has been distributed to over
120 sites. He provided an interactive
demonstration of the software’s capa-
bility to track information on cancer pa-
tients, including demographics,
procedures, diagnoses, treatments, and
reports. “With the searching technol-
ogy currently available, we are now
able to quickly locate the proverbial

lle in the havstack. to the henefit
of our patients,’ Dr. Benjamin cot-
cluded.

The third speaker was Lawrence
Schwartz, MD, department of radiol-
ogy, Memorial Sloan-Kettering Cancer

Two of the presenters at yesterday’s debut of PG 20: Course Chairman Dr. Zuidema
(left) and panelist Dr. Anast.

Center, New York, NY. Dr. Schwartz
discussed the components of voice rec-
ognition systems and their future in the
surgeon’s office. He described the
three classifications of voice recogni-
tion systems—vocabulary based,
speaker dependence, and speech con-
tinuity. Dr. Schwartz told the audience
that in the very near future, large vo-
cabulary, continuous speech voice rec-
ognition will replace current methods
of dictation technology. “The possibili-
ties regarding rapid transcription turn-
around are fascinating and will almost
certainly have a profound impact on the
management of the surgeon’s office,”
Dr. Schwartz said. A stimulating dem-
anetration of the latest voice recoegni-
tion technology conciuded the
presentation.

The fourth speaker was Elaine
Remmlinger, a principal with Health-
care Management Counselors, New

A career in itself

t yesterday’s debut of the two-
day postgraduate course (20),
“Aging and Retirement: A
Challenge to Surgeons,” pan-
elists explored the varied and some-
times vexing aspects of life after the op-
erating room. The course is designed
to appeal to both younger and older sur-
geons, as well as their spouses, as it
reviews financial planning, career oppor-
tunities, and social and cultural issues.

The Chairman of the course is
George D. Zuidema, MD, FACS, Ann
Arbor, MI.

The Tuesday portion of the course ex-
amined “Voluntary Retirement,” and
“Will You Outlive Your Resources?” and
today’s portion will explore “Unplanned
Retirement and the Surgeon” and “Ad-
ministrative Issues in Involuntary Re-
tirement.”

According to statistics cited by
speaker Richard O. Kraft, MD, FACS,
Ann Arbor, MI, the average retirement
age for the general surgeon is 63, and
many North American Hospitals set
mandatory retirement between ages 65

York, NY, who spoke on physician
practice management systems. Accord-
ing to Ms. Remmlinger, because of
managed care a practice management
system is no longer an option—it is es-
sential to participate in a referral net-
work, to collect copayments and fees,
to file electronic claims, to comply with
case management, and to report out-
comes. Today’s information systems
must include the following compo-
nents: patient management, capitation
management, patient care, managed
care administration, knowledge data-
bases, telemedicine, and office automa-
tion tools.

Some potential problems and thorny
issues with commercial software sys-
tems, Ms. Kemmlinger said, revolve
around data privacy (physician and
patient), medicolegal implications,

(continued on page 4)

to 70. Setting and accepting a target
retirement date, he suggested, is pru-
dent. He also noted that an increasing
number of professional medical societ-
ies are exhibiting an interest in assist-
ing members through retirement.
George T. Anast, MD, FACS, of
Minocqua, WI, tackled the topic of
“How to Manage a Successful Retire-
ment,” and told the audience that “re-
tirement is a career in itself.” Dr. Anast
discussed the realizations and
transmogrifications attendant with re-
tirement, noting that “far and away, the
most important aspect of retirement is
psychological,” since physicians tend
to deeply identify themselves by their
profession. Although retirement pre-
sents a “freedom that is unfamiliar,” Dr.
Anast said, “the freedom of retirement
is a treasure and it is yours to spend.”
Aware of its constituents’ growing in-
terest in this area, the ACS will pub-
lish in the forthcoming December 1996
issue of the Bulletin of the American
College of Surgeons results of an in-
depth survey of retirement issues.

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Clinical Congress: A “national treasure”

The following is an excerpt from “A Na-
tional Treasure: The 82nd Clinical Con-
gress of the American College of
Surgeons,” an editorial by Claude H. Or-
gan, MD, FACS, that appears in the Oc-
tober 1996 issue of Archives of Surgery,
vol. 131. Reprinted with permission by
the American Medical Association.

he 82nd Clinical Congress of the
American College of Surgeons
will convene in San Francisco,
CA, from October 6 to 11, 1996.
This meeting for several decades has
been a “gold standard” for surgeons. It
is truly a national treasure. The consis-
tency, quality, and relevance for surgeons
worldwide are earmarks of its success...

The breadth and depth of this pro-
gram is a study in itself. The 1996 Pro-

gram Committee, under the chairman-
ship of James Carrico, MD, FACS, of
Dallas, TX, has again replicated the
work of their predecessors by select-
ing presentations that represent a pan-
oramic assortment of topics involving
surgery, health care reform, basic and
clinical research, education, and policy
and ethical issues. This program repre-
sents all of the major disciplines and
specialties of surgery. The administra-
tive infrastructure and_ the
nonremunerated leadership of the Col-
lege Fellows who participate each year
offer an exciting program that earns the
plaudits of those in attendance...
During the 1995 to 1996 year, the
American College of Surgeons has been
ably represented by a goodwill ambas-
sador extraordinaire in the person of

Justice for patient

and MD sought

From a childhood appreciation of the
Pledge of Allegiance through her Pledge
of Fellowship in the American College
of Surgeons, Anna M. Ledgerwood, MD,
FACS, has taken seriously her duties to
fellow citizens and patients. And yet, ex-
periences with malpractice suits “nearly
ended my career.”

On Tuesday, Dr. shared
her personal experiences as a trauma
surgeon during the Scudder Oration on
Trauma, “With Liberty and Justice for
All.” Dr. Ledgerwood is director, surgi-
cal ICU, and vice-chief of surgery, De-
troit (MI) Receiving Hospital.

She told the audience that surgeons are
reluctant to discuss with colleagues their
malpractice experiences, and she chal-
lenged surgeons to openly explore these
unfortunate events in order to improve
their skills and their service to patients.

Some facts that may place the trauma
surgeon in the path of a lawsuit, Dr.
Ledgerwood said, are: an emergency
room patient’s injury is sudden, and he
or she has no time to prepare or choose

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a physician or hospital; there is an in-
ability or limited ability to communicate
with the patient, as he or she may be
in a mentally compromised state; and
it is difficult to establish a rapport with
the family due to their possible state of
hysteria in the emergency room.

“Our current system of justice,” Dr.
LA dg rwood said, “gives us libel Ly.
Part of that liberty, she continued, is
the liberty to claim injustice. When a
patient claims injustice, she recom-
mended that surgeons: do not get an-
gry at the patient, family or attorneys;
do not criticze others involved in the
case; do not attempt to be experts in
an unknown area; prepare well for depo-
sition and trial; assist their attorney; and
“leave your ego at home.”

Finally, Dr. Ledgerwood discussed
her activites and observations as a 10-
year participant on the ACS Committee
on Trauma’s Verification Review Com-
mittee. Such programs, she believes,
help physicians examine and improve
the care they provide.

The following companies have supported the Clinical Congress with
advertisements in the Exhibit Guide section of this issue:

Appleton & Lange

Applied Medical Resource

Bayer Corporation/Pharmaceutical
Division

Circon Corporation

Cogent Light

Davol Inc.

Ethicon Endo-Surgery

Ethiskill, A Division of Ethicon

Fischer Imaging Corporation

Genzyme Corporation

LORAD Medical Systems

MedChem Products, Inc.

MegaDyne Medical Products, Inc.

ME 92 Operations

Meadox Medicals/Boston Scientific
Corporation

Rhone-Poulenc Rorer
Pharmaceuticals, Inc.

United States Surgical Corporation

2 The American College of Surgeons October 9, 1996

the current President, LaSalle D. Leffall,
Jr., MD, of Howard University, Wash-
ington, DC. This well-deserved honor
represents a milestone in the history of
the American College of Surgeons. By
the time he completes his Presidency,
this mediagenic leader will have trav-
eled more than 100,000 miles. These
travels have taken him to Hong Kong
(to inaugurate the newest foreign chap-
ter of the College), Singapore, South
Africa (where he received an honorary
fellowship from the College of Surgeons
of South Africa), Spain, England, Ger-
many (representing the College at their
joint meeting with the German Surgi-
cal Society), and Halifax, Nova Scotia
(to receive an honorary fellowship in
the Royal College of Physicians and Sur-
geons of Canada)...

At the Convocation of the College on
Thursday evening, October 10th, the
reigns of leadership will be transferred
to David Murray, MD, FACS, an emi-
nent orthopaedist from the State Uni-
versity of New York at Syracuse and
former Chairman of the Board of Re-
gents of the College...

Dr. Murray has been an active Fel-
low of the College, serving on numer-
ous local, regional, and national
committees of the College. He was a
Regent from 1985 to 1994 and served
as Chairman of the Board of Regents
from 1993 to 1994. Congratulations to
David G. Murray, MD, FACS, for this
deserved honor.

Claude H. Organ, Jr., MD
Editor of the Archives of Surgery
Oakland, CA

Barbara A. Barlow, MD, FACS, Is the 1996 recipient of the National Safety Council’s
Surgeons’ Award for Distinguished Service to Safety. Nominated by the ACS Committee
on Trauma and the American Association for the Surgery of Trauma, Dr. Barlow was
recognized for her years of dedication as a physician, educator, researcher, and
volunteer for the prevention of pediatric injury. She Is chief of pediatric surgery at New
York’s Harlem Hospital, president of the New York Surgical Society, and currently a
member of the Committee on Trauma. Presenting the award on Monday evening was
Noel Bufe, PhD (left), of Northwestern University’s Trauma Traffic Institute, represent-
ing the National Safety Council. Drs. Bufe and Barlow were joined by Richard Tippie
(right), Executive Director, Member Services, National Safety Council.

a Sa eR Gas is ho Ra
Clinical Congress News

VOLUME 47 NUMBER 3

Editor:

Stephen J. Regnier
Associate Editor:

Jennifer F. Herendeen
Assistant Editor:

Tina Woelke

Photography Editor:

Donna Gibson

Director of Communications:
Linn Meyer

Photography: Chuck Giorno Photography
Published daily October 6-11

Office: Room 234

Moscone Convention Center

Phone: 978-3620

Items of interest or information must
be reported to the office of the Clini-
cal Congress News by 11:30 am on the
day preceding the desired day of pub-
lication.

Optimism sought and found at seminar

ga eeking Optimism in

the Coming System of

Medical Care” was

the ambitious topic of

yesterday’s Science and Humanism
Seminar.

Expressing concern about the semi-
nar title, moderator C. Rollins Hanlon,
MD, FACS, said that no “intimation
that this presentation will make you
happier about the current state of af-
fairs” was implied. He told the audi-
ence that although none of the
panelists had any “sure-fire” method or
solution for coping with the coming
system of medical care, several inter-
pretations and suggestions would be
offered.

Offering viable and at times upbeat
suggestions were Bruce E. Spivey, MD,
FACS, and Howard M. Spiro, MD. Dr.
Spivey is a distinguished professor of
ophthalmology and is president and
CEO of Northwestern Healthcare Net-
work, Chicago, IL. Dr. Spiro is an
internist, author of texts on gastroen-
terology, and currently director of the
program on humanities and medicine
at Yale School of Medicine, New Ha-
ven, CT.

Dr. Spivey began by discussing many

of the challenges facing surgeons to-
day, specifically the challenge to be or-
ganizers or integrators of populations,
not just patients.

However, he told the audience,
“we’re not unique” in having to con-
front market consolidation, and pointed
out that others such as banks and gro-
cery stores are dealing with similar is-
sues.

In looking ahead to the next 10 years,
Dr. Spivey issued the caveat that “the
successes of yesterday are sometimes
the implosions of today,” and gave as
examples several previously touted and
successful managed care corporations
that have either floundered or have re-
cently merged with larger corporations.

Although networks of care are inevi-
table, he said that “no proven formula
for success exists,” and cautioned sur-
geons to be careful when making deci-
sions about managed care alliances.

On a positive note, he said that some
organizations appear to be stable and
that, interestingly, the successful orga-
nizations are those that are essentially
physician-led, such as Mayo. The fu-
ture, he concluded, “will require a col-
legial and, at the same time, a
competitive posture.”

Tenth CORE Symposium

set for Chicago, i997

The College’s Committee on Oper-
ating Room Environment (CORE)
will hold its 10th symposium at the
Palmer House Hotel in Chicago, IL,
May 12-13, 1997. The theme for the
1997 meeting is Information Tech-
nology for Operating Room Teams.
Conducted in cooperation with the
Association of Operating Room
Nurses, Inc., and the American So-
ciety of Anesthesiologists, the CORE
Symposium is intended to improve
communications among operating
room teams and to strengthen their
understanding of the issues directly
affecting today’s operating room.
The two-day conference will fea-

Program Changes

ture a keynote speaker and four pan-
els of nationally recognized experts
who will address the following infor-
mation/technology topics: data ac-
quisition, creating the competent OR
team, strategies for success—mod-
els that work, and OR clinical path-
ways.

The registration fee of $450 per per-
son includes meeting materials, a wel-
coming reception, continental
breakfasts, and luncheons.

For further information or to obtain
a registration form, contact Rhonda
Peebles at College headquarters: tel.
312/664-4050; fax 312/440-7014; e-mail
rpeebles@acs.org.

General Sessions

In Wednesday morning’s Cancer Symposium, entitled “Surgery Case Manage-
ment Conference: Malignancies of the Neck,” Robert J. Stratta, MD, FACS, was
mistakenly listed as a member of the program.

Specialty Sessions

Dr. Nelson H. Goldberg will replace Mack L. Cheney on the Thursday morning
Plastic Surgery panel discussion on “Contemporary Management of Soft Tissue

Trauma of the Head and Neck.”

Technical Exhibits
Juzo is now located in Booth 3039.

Left to right: Dr. Spiro, Dr. Hanlon, and Dr. Spivey.

Dr. Spiro began by stating, “It’s hard
for me to believe that we’re going to
see this system survive in the long-
term—no one voted for it.” The weak-
ness of the current managed care
system, he said, is that it ignores teach-
ing, research, and social cost—a seri-
ous detriment to medical care.

Dr. Spiro continued, “We have ac-
cepted supinely the notion that we are
providers. We’re physicians, they’re
patients...not providers and consum-

ss -
a Ss

ers.” Underlying the semantic differ-
ences, Dr. Spiro reminded the audi-
ence, is the notion that the modus
operandi of a physician is “do no harm,”
while the motivation of a provider is
marketplace gains.

Finally, he pointed out that “the sys-
tem can’t go without the doctors and
nurses,” and he reiterated the familiar
yet imperative cry for surgeons to be-
come involved as leaders in medical
care.

y

This year’s Distinguished Philanthropist Award was presented to Nell C. Clements, MD,
FACS (left), and his wife, Ginny, by ACS President LaSalle D. Leffall, Jr., MD, FACS,
during the Fellows Leadership Soclety’s elghth annual luncheon, which took place

Monday at the Westin St. Francis Hotel.

The ACS Eastern States Committees
on Trauma will sponsor “Trauma and
Critical Care 1997, Point/Counter-
point XVI.” The meeting will be held
June 11-13, 1997, at the Boston Park
Plaza Hotel, Boston, MA. For further
information, contact Kimball I. Maull,

1997 trauma/critical care
meeting set for Boston

MD, FACS, Department of Surgery—
110-3276, Loyola University Medical
Center, 2160 S. First Ave., Maywood,
IL 60153; tel. 708/327-2682, fax 708/
327-2698, or call the ACS Trauma
Department at 312/664-4050, ext.
342.

The American College of Surgeons October 9, 1996 3

Medical students attending this year’s Congress and members of the Committee on Sur
Top row, left to right: Norman J. Snow, MD, FACS, Cleveland, OH; Mitchell Hawkey,
NE; Merril T. Dayton, MD, FACS, Salt Lake City, UT; Kenneth Sharp,
Washington, Seattle, WA; Matthew Stahiman, University of Texas,
Antonio, TX; Roger Nagy, University of New Mexico, Albuquerque,
Burlington, VT; Errol Buntuyan, University of California, Irvine,
Alberta, Edmonton, AB. Middle row, left to right: Steven Ruby,
California, La Jolla, CA; Dennis Glatt, University of South Dakota, Sioux Falls, SD; Adnan Din, University of California,
Vancouver, BC; Julie Hamilton, Wright State University, Dayton, OH; Karin Barbara Cesario, University of Colorado,
AZ; Maxine Anderson, Charles R. Drew University, Los Angeles,
Coberly, University of lowa, lowa City, IA; Daniel Heiner,
of California, San Francisco, CA; Brent Davis, Texas A & M University,
Jennifer Curry, University of Rochester, Rochester, NY; Albert Ko,
College of Medicine, Houston, TX; Tim Riegel,
Saskatchewan, Saskatoon, SK; Karen E. Deveney, MD, FACS, Chairman,

University of Kansas, Kansas City,

University of Calgary, Calgary, AB, Joshua Tepper,

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gical Education in Medical Schools gathered for a group picture on Sunday evening.
Oregon Health Sciences University, Portland, OR; Jeffrey Toman, Creighton University, Omaha,
MD, FACS, Nashville, TN; Richard W. Schwartz, MD, FACS, Lexington, KY; Matt Rawlins, University of
Houston, TX; John Boskind, Loma Linda University, Loma Linda, CA; Jeffrey Apple, University of Texas, San
NM; William Pearce, University of Southern California, Los Angeles, CA; David Smail, University of Vermont,
CA; Andrew Nowalk, PhD, The American Medical Student Association, Reston, VA; and Daren Lind, University of

MD, FACS, Farmington, CT; Brad Winterstein, University of Nebraska, Omaha, NE; Zandra Cheng, University of
Davis, CA; Nadine Caron, University of British Columbia,
Denver, CO; Tiffany Danton, University of Arizona, Tucson,
CA; Burnetta Herron, University of Texas, Galveston, TX; Catherine Cothren, University of Texas, Dallas, TX; Dana
KS; Ronnie Ann Rosenthal, MD, FACS, New Haven, CT; Michael Pickart, University
College Station, TX; and Drew Van Boerun, University of Utah, Salt Lake City, UT. Bottom row, left to right:
University of Hawaii, Honolulu, HI; Cassandra Joffs, University of Nevada, Reno, NV; Christophe Nguyen, Baylor
McMaster University, Hamilton, ON; Suzanne Meiers, University of
Portland, OR; James C. Herbert, MD, FACS, Burlington, VT; Leigh Anne Neumayer, MD, FACS, Salt Lake

City, UT; John Kim, Stanford University, Stanford, CA; Suzanne Kim-Doud Galli, SUNY Health Science Center, Brooklyn, NY; Thomas G. Lynch, MD, FACS, Omaha, NE; and Edward

L. Johnson, MD, FACS, Albuquerque, NM.

Hypertonic saline may reverse ARDS in trauma patients

ould adult respiratory dis-
tress syndrome (ARDS), a
life-threatening inflammatory
lung condition that afflicts
about 10 percent of trauma patients,
be prevented simply by doubling the
amount of salt in standard resuscita-
tion fluids that trauma patients receive
anyway? That is the research ques-
tion that surgery professor David B.
Hoyt, MD, FACS, is investigating.

Dr. Hoyt and his laboratory staff at
the University of California, San Diego,
Medical Center, have been studying
immunosuppressive agents for the last
12 years. As part of that work, the
researchers have noticed that high con-
centrations of salt affect immune sys-
tem cells in the test tube, and they
postulated that hypertonic saline may
physiologically influence the inflamma-
tory process in living animals.

Therefore, for the past three years
Dr. Hoyt and his colleagues have evalu-
ated the role that hypertonic saline may
play in reducing the number of inflam-

as lla tn thea 1 . 7 i I<
following an insult that led to shock.
A study reported earlier this week at a
session of the Owen H. Wangensteen
Surgical Forum by research resident
Niren Angle, MD, assessed the degree
of lung damage and the number of in-
flammatory cells in the lungs of ani-
mals that had sustained hemorrhagic
shock after standard resuscitation with
Ringer’s lactate or resuscitation with
hypertonic saline, which contains two
times more sodium chloride than stan-
dard saline.

The animals that received Ringer’s
lactate had more hemorrhage in the
alveoli and more fluid and white blood
cells in the lung tissue than the ani-

mals treated with hypertonic saline. The
overall degree of inflammatory injury in
the lungs was significantly higher for
animals treated with Ringer’s lactate.

Despite findings from this and other
studies in animals, Dr. Hoyt believes
that it is premature to conclude that hy-
pertonic saline protects the lungs from
ARDS. Hypertonic saline still must be
tested with other animals, and its mecha-
nism of action in the lungs must be
learned.

Because hypertonic saline has been
considered as a possible resuscitation
fluid for shock patients in the past, it
has been used in clinical trials. “So we
know it is a safe product,” Dr. Hoyt said.
However, hypertonic saline is not cur-
rently manufactured as an intravenous
solution. “It’s not as readily available as
you might think; we have to concoct it
ourselves,” he added.

Nevertheless, the use of hypertonic
Saline in the resuscitation of patients
in shock is an intriguing notion. “Hav-
ing any treatment available with the
potential to reverse early onset ARDS
is exciting because all we can do now
is treat the condition after the fact by
supporting the patient on a ventilator
until the disease gets worse or the pa-
tient gets better,” Dr. Hoyt said.

Studies of hypertonic saline also may
provide insight into the inflammatory
process itself. “This is a field that
should lead to a completely different
concept of resuscitation by providing a
better understanding of what turns par-
ticular inflammatory cells on and off,”
Dr. Hoyt said.

Copies of the Owen H. Wangensteen
Surgical Forum, Volume XLVII, are
available for $25 each in the general
registration area of Moscone Center.

ee SR a a en nn ee

COMPUTERS, from page 1

clinical protocols and best practices,
structuring system contracts to allow
for future affiliations, and connectivity.
“By the year 2000, offerings in prac-
tice management systems will be more
mature and will result in an almost to-
tally integrated physician practice
workstation,” Ms. Remmlinger said.
The fifth speaker was Daniel R.
Masys, MD, FACP, director of biomedi-
cal informatics, University of Califor-
nia-San Diego School of Medicine, who
spoke on computer-assisted profes-
sional education. Dr. Masys provided
an Overview of computer-assisted in-

struction from its genesis in the 1960s
to the present. He described and dem-
onstrated several full-text medical da-
tabases now available to physicians,
including CancerNet of the National
Cancer Institute.

According to Dr. Masys, the
strengths of computer education tech-
nology include: self-direction, availabil-
ity, interactivity, quick retrieval of
specific data, and an ever-growing res-
ervoir of information. Some of the
weaknesses, Dr. Masys said, include
abnormally low-resolution video, rap-
idly changing standards for digital mul-

4 The American College of Surgeons October 9, 1996

timedia applications, and limitations of
current technologies.

The final speaker was M. Michael
Shabot, MD, FACS, who is with the
surgical intensive care unit at Cedars
Sinai, Los Angeles, CA.

Dr. Shabot provided a historical over-
view of the Internet, which owes its
origins to the launching of Sputnik in
1957 by the U.S.S.R. This event re-
sulted in the formation of the Advanced
Research Project Agency, the group re-
sponsible for initiating the basis of the
Internet. The Internet was intended to
connect research centers and provide

a military communications tool that
could be maintained even in the event
of nuclear war, Dr. Shabot said.

Today, the World Wide Web is part
of the Internet. Dr. Shabot noted that
as of September of this year, the num-
ber of websites worldwide is doubling
every 93 days. The government gave
up funding the Internet a number of
years ago, and it is now totally com-
mercially underwritten.

Dr. Shabot concluded his presenta-
tion with an interactive demonstration
of the College’s website and discussed
potential areas for future expansion.

y stimulating the immune
system to mount an attack
against residual malignan-
cies within the liver, re-
searchers from Memorial Sloan
Kettering Cancer Center, New York,
NY, may find a way to counteract a par-
ticularly difficult cancer treatment prob-
lem: how to prevent recurrence of liver
tumors.

Cancer recurs in as many as 70 per-
cent of patients with primary or meta-
static liver tumors because surgeons
are not able to remove a tumor com-
pletely, or because they cannot detect
microscopic metastases that may be
present.

The only effective treatment for pri-
mary or metastatic liver cancer is to
perform a surgical procedure, but

Visit the exhibits

The scientific and technical exhibits will be open from 9:30 am to 3:30 pm
today and from 9:30 am to 1:30 pm Thursday.

Trauma advances seminar

slated for December

he College’s Committee on
Trauma, Region VII (Iowa,
Kansas, Missouri, and Ne-
braska), is sponsoring the
19th annual “Advances in Trauma”
seminar at the Ritz-Carlton Hotel in
Kansas City, MO, on Friday, Decem-
ber 13, and Saturday, December 14,
1996.

SI rmen |
planned a program that will benefit all
those physicians involved in trauma pa-
tient care. Program chairmen are: Rob-
ert L. Coscia, MD, FACS, chief, Region
VII; Thomas M. Foley, MD, FACS,
Iowa state chairman; Frederic C.
Chang, MD, FACS, Kansas state chair-
man; Michael H. Metzler, MD, FACS,
Missouri state chairman; and Joseph
C. Stothert, Jr., MD, FACS, Nebraska
state chairman.

The purpose of this continuing medi-
cal education course is to provide an
update on information and techniques
used in the treatment of the acutely ill
and injured patient. The Friday pro-
gram will include presentations on: Re-
suscitation of the Severely Injured
Child; Manifestation of Minor Head In-
jury; Clearing the C-Spine; Cardiac
Contusion—Not; Neurovascular Com-
plication of Head Injury and the Visual
System; Complex Pancreatic/Duodenal
Injuries; 15 Rounds with the DEA;
Complex Liver Injuries; The Real
Meaning of Multidisciplinary Care of
the Injured Child; and Problem Cases
in Trauma.

Saturday’s programming will include
sessions on: Trauma Center Cost Re-
duction; Dedicated Trauma Program

A iit

Effect on Outcome; Disaster Manage-
ment in Terrorist Incidents; DVT Pro-
phylaxis—To Screen or Not; The
Mangled Extremity; Abdominal GSW’s
—Role of Selective Nonoperative Man-
agement; Who Takes Care of the Pa-
tient in the ICU?; The Injured Colon
—Is Colostomy Needed?; Should We
Save the Adult Spleen?; and Cases from

Faculty members include: Richard
M. Bell, MD, FACS, Columbia SC;
Demetrios Demetriades, MD, PhD, Los
Angeles, CA; David V. Feliciano, MD,
FACS, Atlanta, GA; Julius M. Goodman,
MD, FACS, Indianapolis, IN; Kenneth
L. Mattox, MD, FACS, Houston, TX; J.
Wayne Meredith, MD, FACS, Winston-
Salem, NC; Joseph J. Tepas III, MD,
FACS, Jacksonville, FL; Donald D.
Trunkey, MD, FACS, Portland, OR;
John A. Weigelt, MD, FACS, St. Paul,
MN; and Charles C. Wolferth, MD,
FACS, Philadelphia, PA.

The fee for physicians is $350, for
critical care nurses is $200, and for resi-
dents is $150. For those individuals
who wish to attend only one day of the
program, the fee is 60 percent of the
total registration. A late registration fee
of $25 will be added unless the regis-
tration is postmarked before Novem-
ber 20, 1996.

While it will be possible to register
for the program in Kansas City, ad-
vance registration is strongly recom-
mended. For more information on the
program or to obtain an application for
enrollment, contact the ACS Trauma
Department at 55 E. Erie St., Chicago,
IL 60611, tel. 312/664-4050, ext. 342.

Registration totals

As of Tuesday afternoon, total registration for the Clinical Congress was
15,152. Of that number, 9,441 were physicians and 5,711 were exhibitors,
guests, spouses, or convention personnel.

this approach also has an unfortunate
effect. Surgical removal of the dis-
eased portion of the liver accelerates
the growth of any tumor fragments
that may be left behind. However, ac-
cording to the results of animal ex-
periments reported Monday
afternoon at a session of the Owen
H. Wangensteen Surgical Forum,
preoperative administration of
gamma interferon and a genetically
modified cytokine vaccine may retard
the growth of residual liver cancer.

The researchers found that gamma
interferon administered before liver re-
section helps delay regrowth of tumors
by acting on the Kupffer cells, which
are specialized liver immune system
cells. “Our initial hypothesis was that
liver resection itself was immunosup-
pressive and that it impaired the func-
tion of the Kupffer cells. So any tumor
cells in the liver would grow because
the Kupffer cells couldn’t keep them
in check. We speculated that if we gave
gamma interferon before the operation,
it might prevent immunosuppression of
the liver, stimulate the Kupffer cells to
act more normally, and kill more tu-
mor cells,” Howard Karpoff, MD, a sur-
gical resident at New York University
Medical School, said.

However, treatment targeted solely
at the Kupffer cells would be limited
to the liver itself. Dr. Karpoff explained
that the human immune system has
two arms—cell-mediated immunity,
which is produced by macrophages like
the Kuppfer cells, and more long-term
systemic immunity, which involves lym-
phocytes that circulate in the blood-
stream.

In order to induce circulating lym-
phocytes to destroy liver tumor cells
in addition to the Kupffer cells, Dr.
Karpoff formulated a liver tumor-spe-
cific vaccine that also cloned gene
sequences for two cytokines—
interleukin-2 (IL-2) and granulocyte/
macrophage colony stimulating fac-
tor (GMCSF)—and utilized herpes
simplex as a viral vector.

In a series of experiments in animals
conducted by Dr. Karpoff when he was
a research fellow in the laboratory of
Yuman Fong, MD, at Memorial Sloan
Kettering Cancer Center, gamma inter-

Stimulation of immune system may
prevent recurrence of liver cancer

feron intensified the function of the
Kupffer cells, while the cytokine vacci-
nation increased lymphocyte activity.

The vaccine and the gamma inter-
feron also significantly reduced liver
tumor burden. The number of tumor
nodules in animals after surgical resec-
tion and treatment with the two com-
pounds was nearly the same as the
number of nodules in animals that had
undergone simple laparotomy. “The
treatment for the most part offset the
effect of liver resection on tumor
growth,” Dr. Karpoff said.

Gamma interferon potentially could
be applied to patients with liver can-
cer. “There would be virtually no mor-
bidity associated with giving patients
gamma interferon before surgery for
liver cancer or colon cancer that me-
tastasizes to the liver. By giving pa-
tients gamma interferon, we may
improve Kupffer cell surveillance in the
liver, which might decrease metastases
later on,” he added.

Cytokine vaccines cannot be applied
to human beings at the present time,
however, for two reasons. First, the
most effective combination of cytokines
for vaccination is not known.
Interleukin-2 and interleukin-12 as well
as other types of cytokines may pro-
duce a stronger immune response than
IL-2 and GMCSF.

Second, it is more difficult to gener-
ate an immune response in humans
than in animals. According to Dr.
Karpoff, the immune responses pro-
duced by vaccines in animals target
cancers in a particular cell line. Unfor-
tunately, human beings do not have a
uniform type of cancer cell line.

Dr. Karpoff nevertheless suggested
that a herpes virus vector might be
used to deliver a vaccine directly into
a liver tumor rather than into the
body’s circulatory system. By admin-
istering a vaccine in this way, the body
might be able to mount an immune re-
sponse to the cancer cell lines that re-
side in the tumor and prevent
recurrence of cancer from these cells,
Dr. Karpoff concluded.

Copies of the Owen H. Wangensteen
Surgical Forum, Volume XLVII, are
available for $25 each in the general
registration area of Moscone Center.

EE GAAP) Sy RR aE RT i i aS
Managed care information highway

If you have questions about or are having problems with managed care, be
sure to stop by the managed care information booth in the North Lobby of
Moscone Center. Sponsored by the College’s Socioeconomic Affairs De-
partment, the booth is staffed by a professional managed care consultant
from Conomikes Associates, Inc., who will provide a complimentary consul-
tation on managed care issues and problems.

Fellows can also stop by the booth and register for any of the College's
managed workshops that are scheduled for 1996-1997.

The American College of Surgeons October 9,1996 5

Allied Meetings

Wednesday

Morning

International Society of Surgery, U.S.
Chapter

6:45 am - 8:00 am. Breakfast meeting.
Hilton, Bldgs. 1, 2, 3, Ballroom level,
Continental 8.

Association of Women Surgeons

7:00 am - 8:30 am. Breakfast.

Westin St. Francis, Floor 2, California
East.

American Society of Colon and Rectal
Surgeons—Cooperative Clinical Trials
7:00 am - 8:30 am. Breakfast meeting.
Hilton, Bldg. 3, Floor 4, Union
Square 7.

American Society of Colon and Rectal
Surgeons—Young Researchers
Committee of RF

7:00 am - 8:30 am. Breakfast meeting.
Hilton, Building 3, Floor 4, Union
Square 8.

Mosby Yearbook, Inc.

7:00 am - 9:00 am. Breakfast meeting.
Hilton, Bldgs. 1, 2, 3, Ballroom level,
Franciscan A.

American Society of Colon and Rectal
Surgeons—Self-Assessment
Committee

/:30 am - 4:30 pm. Breakfast/lun-
cheon.

Hilton, Bldg. 3, Floor 4, Union
Square 9.

American Society of Colon and Rectal
Surgeons—Committee on
Technologies

8:00 am- 10:00 am. Breakfast meet-
ing.

Hilton, Bldg. 3, Floor 4, Union
Square 16.

Afternoon

American Society of Colon and Rectal
Surgeons—Membership Committee
12:00 noon - 1:00 pm. Luncheon.
Hilton, Bldg. 3, Floor 4, Union
Square 16.

Central Surgical Association
Membership Committee

12:00 noon - 3:00 pm. Luncheon.
Hilton, Bldg. 2, Grand Ballroom level,
Green Room.

Central Surgical Association
Foundation

4:30 pm - 5:30 pm. Meeting.
Hilton, Bldg. 3, Floor 4, Union
Square 15.

Evening

World Journal of Surgery/Springer-
Verlag

9:00 pm - 7:00 pm. Reception.
Hilton, Bldg. 3, Floor 4, Union
Square 16.

American Society of Colon and Rectal
Surgeons—Residents

9:00 pm - 7:00 pm. Reception.
Moscone Center, Mezzanine level,
Rooms 274-276.

San Joaquin Surgical Department
9:00 - 7:00 pm. Reception.
Hilton, Citiscape.

Uniformed Services University,
Surgical Associates Military
Reception

9:30 pm - 7:00 pm. Reception.
Hilton, Bldgs. 1, 2, 3, Lobby level,
Plaza A.

University of Colorado Department of
Surgery

9:30 pm - 7:30 pm. Reception.

Hilton, Bldgs. 1, 2, 3, Ballroom level,
Continental 8.

American College of Surgeons, North
Dakota Chapter

9:30 pm - 7:30 pm. Reception.
Hilton, Bldg. 3, Floor 4, Union
Square 2.

Friends of Harlem Hospital
9:30 - 7:30 pm. Reception.
Fairmont Hotel, Empire Room.

Case Western Reserve University
6:00 pm - 7:30 pm. Reception.
Hilton, Bldgs. 1, 2, 3, Lobby level,
Plaza B.

University of Washington Henry N.
Harkins Surgical Society

6:00 pm - 8:00 pm. Reception.

Westin St. Francis, Floor 2, California
West.

Metropolitan Group Hospitals
Residency in General Surgery
6:00 pm - 8:00 pm. Reception.
Fairmont Hotel, Lobby level, Green.

Society of Graduate Surgeons of
USC/LAC

6:00 pm - 8:00 pm. Reception.
Hilton, Bldg. 3, Floor 4, Union
Square 3-4.

Gay and Lesbian Medical Association
6:00 pm - 8:00 pm. Meeting.

Davies Medical Center, Floor 1,
Room TBA.

Providence Hospital Surgical Alumni
Association

6:00 pm - 9:00 pm. Reception.
Marriott, Floor 5, Sierra K.

Association of Iranian Surgeons
6:30 - 8:30 pm. Dinner meeting.
Maykadeh Restaurant, 470 Green St.

North American Chinese Surgical
Society

6:30 - 8:30 pm. Annual dinner.
Harbor Village Restaurant, Four
Embarcadero Center.

University of Vermont/American
College of Surgeons, Vermont
Chapter

6:30 pm - 7:30 pm. Reception.
Campton Place Hotel.

Friends of Bill W

7:00 pm - 8:30 pm. Meeting.
Hilton, Bldg. 3, Floor 4, Union
Square 1.

Michigan State University
Department of Surgery

7:00 pm - 9:00 pm. Reception.
Marriott, Lower B-2, Salon 10.

Matthew Walter Surgical Society,
MeHarry Medical College

7:00 pm - 10:00 pm. Dinner.

Hilton, Bldgs. 1, 2, 3, Ballroom level,
Yosemite B.

Thursday

Morning

American Society of Colon and Rectal
Surgeons—Outcomes Committee
7:00 am - 8:30 am. Breakfast meeting.
Hilton, Bldg. 3, Floor 4, Union
Square 2.

Congress Chronicle

A surgeon “must constantly

be a student”

The 46th Clinical Congress, which took
place in San Francisco in 1960, featured
the Presidential Address by I. S.
Ravdin, MD, FACS, professor of sur-
gery at the University of Pennsylvania

Crehanl nf Med}j > Z , d £ I
_ - . ; = * ‘ a

I.S. Ravdin Lecture in the Basic Sci-
ences is dedicated.

Dr. Ravdin spoke on “Whither Goest
the American Surgeon,” during which
he told the audience: “The responsi-
bilities which the surgeon accepts
when he agrees to take care of a pa-
tient are enormous. He must assure
himself that as far as possible a rea-
sonably accurate diagnosis has been
made, and that an operation is
indicated...He must anticipate compli-
cations and if possible prevent them.

t s1
WOT Une

He must by every possible means
speed the recovery of the patient, and
he must to the best of his knowledge
be sure that he has chosen wisely the
operation calculated to cure the patient,
or to provide the longest survival. If he
is to do these things, he must con-
stantly be a student. It he does not
throughout his professional lifetime re-
main a student, he will find himself in
the position of being competent for do-
ing surgery during one period of his
professional life and incompetent in an-
other.”

Douglas W. Wilmore, MD, FACS,
presents the Ravdin Lecture this after-
noon at 1:30 pm in Moscone Center,
Room 134.

Panel to consider postop
venous thromboembolism

A multidisciplinary program sponsored
by the Advisory Councils will be
held this morning to consider “Preven-
tion of Postoperative Venous
Thromboembolism and Its Cost Impli-
cations.” The program will take place
from 9:00 am to 12:00 noon in Room
131 of Moscone Center. H. Brownell
Wheeler, MD, FACS, will serve as
moderator.

This multidisciplinary panel will re-
view prophylaxis of deep vein
thrombosis/pulmonary embolism
(DVT/PE) for the practicing surgeon.
audience interactive response system
technology will allow active participa-
tion by attendees. The program will

highlight practical methods of prophy-
laxis and current indications for their
use. Special consideration will be
given to cost-effectiveness in the
managed care environment and
medicolegal liability related to failure
to employ currently accepted DVT/
PE prophylaxis.

Scheduled topics and presenters
are: General Surgery, by G. Patrick
Clagett, MD, FACS; Neurological Sur-
gery, by Russell D. Hull, MD;
Orthopaedic Surgery, by Guy D.
Paiement, MD; Cardiovascular Sur-
gery, by Lazar J. Greenfield, MD,
FACS; and Trauma, by Steven R.
Shackford, MD, FACS.

6 The American College of Surgeons October 9, 1996

Collagen patch from human placenta
promotes healing of bowel wall

connective tissue patch de-
rived at least in part from
human placenta may provide
the framework by which the
intestine can repair defects in its wall
that cannot be corrected surgically.
The patch has three layers that look
like two. An outer shiny layer is made
of type 4 collagen, which is most resis-
tant to dissolution by bile and pancre-
atic juices and comes from human
placenta. An inner layer contains type
1 and type 3 collagen, which come from
a variety of animal sources.

“The three types of collagen tend to
replicate the three types of collagen in
the bowel wall. The outside layer cor-
responds to the serosa, the middle
layer corresponds to the muscularis,
and the inner layer corresponds to the
mucosa. With the patch, we have pro-
vided scaffolding for all three natural
layers of the bowel wall so guided re-
generation of tissue defects can occur,”
John R. Kirkpatrick, MD, FACS, chair-
man of the department of surgery,
Washington Hospital Center, Washing-

ton, DC, explained. The patch and its
usefulness in animal studies were de-
scribed at a session of the Owen H.
Wangensteen Surgical Forum earlier
this week.

The collagen patch, which was sup-
plied by Saduc-Imedex, Lyon, France,
may provide the first actual treatment
alternative for some patients with short-
gut syndrome. A number of these pa-
tients also have abnormal passages
connecting parts of the intestines, or
fistulas, despite repeated surgical re-
sections of the bowel. Although the pa-
tients may have a sufficient amount of
overall bowel to survive, they must be
maintained on intravenous feeding be-
cause the fistulas interfere with the di-
gestion of solid food.

Others who may benefit from the
patch are individuals who cannot un-
dergo conventional surgical closure of
intestinal fistulas because of extensive
scarring or adhesions, or patients who
suffer leakage of intestinal contents
when anastomoses do not heal after an
operation on the digestive tract. It is

~

estimated that as many as 6 to 10 per-
cent of gastrointestinal anastomoses
fail because of an inadequate blood sup-
ply, intraluminal distention, infection,
or tension on the wound, and up to 20
percent of patients with intestinal fis-
tulas die, according to Dr. Kirkpatrick.

The collagen patch promoted heal-
ing of a small defect corresponding to
25 percent of the total amount of the
anterior cecal wall similar to that seen
with primary surgical closure or fibrin
glue closure in experiments on rodents.
More important, the patch led to com-
plete healing of a large defect corre-
sponding to 80 percent of the anterior
cecal wall which could not be repaired
surgically.

The researchers found that large in-
testinal defects treated with fibrin glue,
which contains the protein commonly
found in blood clots, showed no signs
of tissue union. Ninety percent of the
animals that received fibrin glue died
as a result of the failure of the intes-
tine to close. In contrast, only one ani-
mal in the group that received the

collagen patch died, and the remain-
ing animals exhibited complete regen-
eration of the bowel wall across all
layers. “This is the first time we have
been able to demonstrate in our labo-
ratory that bridging of all three layers
of the bowel wall occurs,” Dr.
Kirkpatrick announced.

Additional investigations of the col-
lagen patch are being conducted in
larger animals to determine if union of
large intestinal defects can be achieved.
“That will be the exciting part, because
if regeneration does not occur, then
over time the patch will either produce
a scar or dissolve, which will not be
appropriate for application in humans.
For the patch to be used at some point
for large intestinal defects in humans,
you have to have bowel wall regenera-
tion,” Dr. Kirkpatrick said.

Copies of the Owen H. Wangensteen
Surgical Forum, Volume XLVII, are
available for $25 each in the general
registration area of Moscone Center.

The “Top Gun Laparoscopic Skill Shoot-Out,” a series of drills and suturing exercises designed to challenge residents’ skill level in performing laparoscopic tasks, took place
Monday afternoon in the scientific exhibits area. The prize was a CD-ROM version of Scientific American Surgery. Dr. Dan Van Cleve of Baylor College took first place, or “Top
Gun.” Dr. Daniel Herron, New England Medical Center, won second place, and Dr. Raja Kandaswamy, Howard University, won third place. The “Shoot-Out” was developed by James
Rosser, MD, FACS, Yale University School of Medicine, New Haven, CT.

The American College of Surgeons October 9, 1996 7

Pictured are the Program Committee of the American College of Sur
A. Brent Eastman, Vice-Chairman, La Jolla, CA; Kirby |. Bland, Me
Surgery, Louisville, KY; J. Roland Folse, Committee on Graduate Medical Education, S

H. Coles, Ophthalmic Surgery, Buffalo,

Committec on Allled Ucealth Percanna!

Member, Galveston, TX; C. James Carrico, Chairman, Dallas, TX; Maria D. Allo, Committee on O
and Maxillofacial Surgery, Chicago, IL; David A. Krusch, Re
Education, Cincinnati, OH; and Douglas J. Mathisen,

a? eo. —
P - J grrr
a t- :

NY; Robert B. Wallace, Cardiothoracic Surgery,
Durham, NC. Middle row, left to right: Edwin L. Kaplan, Committee on Medical Motion
Martin I. Resnick, Urology, Cleveland, OH; John L. D. Atkinson, Neurological Surgery;
Committee for the Forum on Fundamental Surgical Problems, Kansas City,
and Postoperative Care, Chapel Hill, NC; Karen E. Deveney,

gent’s Committee on Informatics,
Cardiothoracic Surgery, Boston, MA.

~ ~ ‘. <e Oo
> : MN é 2 —
>» * . = es art
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geons and Liaison Members. Top row, from left to right: Irving L. Kron, Member, Charlottesville, VA;
mber, Providence,

Rl; David L. Nahrwold, Member, Chicago, IL; Hiram C. Polk, Advisory Council for
pringfield, IL; Bradley M. Rodgers, Pediatric Surgery, Charlottesville, VA; William

Washington, DC; Onyekwere E. Akwari, Committee on International Relations,
Pictures, Chicago, IL; Paul A. Levine, Otorhinolaryngology, Charlottesville, VA;
Maurice J. Webb, Gynecology and Obstetrics, Rochester, MN; Laurence Y. Cheung,
KS; David C. Brewster, Vascular Surgery, Boston, MA; Anthony A. Meyer, Committee on Pre-
Committee on Surgical Education in Medical Schools, Portland, OR. Bottom row, left to right: Ralph J. Doerr,
Puffalin NY: lohn Fo MeDermott Orthanaadic Curcary Seattle, WA: Gerald 0. Strauch. ACS Staff, Chicago, IL; David N. Herndon,
perating Room Environment, San Jose, CA; Robert Lee Walton, Plastic
Rochester, NY; Josef E. Fischer, Committee on Surgical Research and

a i ee

Text offers print/electronic access to latest surgical techniques

cientific American Surgery-
the problem-oriented surgery
text published by Scientific
American Medicine under
the aegis of the American College of
Surgeons-provides the tools for easy
access to information that surgeons
need to compete in today’s cost-sensi-
tive health care environment. Scientific
American Surgery is on display at the
ACS Resource Center and at Booth
3507 in the technical exhibit area.

Now available in a convenient CD-
ROM format as well as the standard
loose-leaf text, Scientific American Sur-
gery provides scores of algorithms for
speedy clinical decision making, quar-
terly print and electronic updates, and
expert tips from master surgeons on
solving operative problems and avoid-
ing potential complications.

This year marked the publication’s
entry into the electronic age with the
release of Scientific American Surgery
CD-ROM. The user-friendly format fa-
cilitates information access through
powerful and flexible searching and
printing capabilities. Interactive fea-
tures enable users to switch between
text and algorithms, and search que-
ries can be saved for future use. If the

user misspells a search term, the
unique Soundex feature automatically
finds a phonetically similar word.

The 4 1/2-inch CD-ROM disc, which
is available in Windows and Macintosh
formats, contains all of the 1,900 pages
of the two-volume loose-leaf text, in-
cluding the publication’s more than
1,200 illustrations.

Another milestone is the publication
this year of seven new chapters on op-
erative technique and five new chap-
ters on common diagnostic dilemmas
confronting today’s surgeons.

In the operative technique chapters,
master surgeons define each operation
as a series of specific steps, demon-
strate their specific technical approach
to a maneuver, and highlight situations
that may cause problems.

In 1996, several master surgeons, in-
cluding John Cameron, MD, FACS,
John L. Sawyers, MD, FACS, and
Carlos A. Pellegrini, MD, FACS,
authored operative technique chapters
on pancreatic surgery, gastric proce-
dures, breast procedures, organ pro-
curement, minimally invasive
esophageal procedures, and thyroid
and parathyroid procedures.

New technique chapters in 1997 will

include “Anal Procedures,” by Ira
Kodner, MD, FACS; “Intestinal Anasto-
mosis,” by Zane Cohen, MD, FRCSC:
and “Biliary Tract Procedures,” by Ber-
nard Langer, MD, FACS, and Bryce
Taylor, MD, FRCSC.

The chapters on common diagnostic
problems feature decision trees keyed
into text, which show in step-by-step
fashion how to manage the problems
in the most efficient and cost-effective
manner.

Other recent chapters on common di-
agnostic problems are: “Acute Abdomi-
nal Pain,” by Romano Delcore, MD,
FACS, and Laurence Y. Cheung, MD,
FACS; “Breast Disease,” by Barbara L.
Smith, MD, PhD, FACS, and Wiley W.
Souba, MD, ScD, FACS; “Upper GI
Bleeding,” by Richard T. Schlinkert,
MD, FACS, and Keith A. Kelly, MD,
FACS; “Lower GI Bleeding,” by Marga-
ret Schnitzler, MBBS, and Robin
McLeod, MD, FACS; “Intestinal Ob-
struction,” by W. Scott Helton, MD: and
“Skin Lesions,” by Alan E. Seyfer, MD,
FACS. Forthcoming in 1997 is a chap-
ter on “Jaundice,” by Jeffrey S. Barkun,
MD, and Alan N. Barkun, MD.

In addition to these chapters, the Sci-
entific American Surgery Bulletin, in-

cluded in each update package, fea-
tures two new columns. In the “Editor’s
Comment” column, members of the
publication’s Editorial Board comment
on a specific surgical technique. The
Fall 1996 Bulletin features comments
by Laurence Y. Cheung, MD, FACS,
on restorative proctocolectomy. In the
new column, “Surgical Practice
Update,” recent literature on important
surgical topics is reviewed. The Fall
1996 Bulletin reviews the role of
endoscopic retrograde cholangio-
pancreatography in the management of
coledocholithiasis in the laparoscopic
era.

The editorial board of Scientific
American Surgery is: Douglas W.
Wilmore, MD, FACS, Chairman;
Laurence Y. Cheung, MD, FACS; Alden
H. Harken, MD, FACS; James W.
Holcroft, MD, FACS; and Jonathan L.
Meakins, MD, DSc, FACS.

For additional information, visit the
ACS Resource Center or Booth 3507
in the technical exhibit hall, or contact
Scientific American Medicine at 415
Madison Ave., New York, NY 10017-
1111; tel. 800/545-0554, fax 212/980-
3062.

8

The American College of Surgeons October 9, 1996